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First Report from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP): Surgical Techniques and Outcomes of 191,909 Laparoscopic Sleeve Gastrectomies.
Elizabeth R Berger*1, Ronald H Clements*2, John M Morton*3, Kristopher Huffman*4, Bruce M Wolfe5, Ninh T Nguyen6, Clifford Y Ko7, Matthew M Hutter*8
1Loyola University Chicago Stritch School of Medicine, Chicago, IL;2Vanderbilt University Medical Center, Nashville, TN;3Stanford University Medical Center, Stanford, CA;4American College of Surgeons, Chicago, IL;5Oregon Health and Science University, Portland, OR;6University of California, Irvine School of Medicine, Irvine, CA;7University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA;8Massachusetts General Hospital, Boston, MA

OBJECTIVE(S):
Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure. The MBSAQIP collects clinically-rich, bariatric-specific data nationwide. Starting in 2011, variables were added to assess procedural-specific technical variation in LSG including the use of staple line reinforcement (SLR) vs. oversewing vs. stapling alone, bougie size(BS), and stapling distance from the pylorus(DP). This is the first report from the MBSAQIP and the first study comparing surgical techniques with outcomes for LSG using nationwide, bariatric-specific data.
METHODS:
Univariate analyses and hierarchical logistical regression models were developed to analyze outcomes for techniques of LSG performed at MBSAQIP accredited centers.
RESULTS:
There were 191,909 LSG operations performed at 721 centers from 2011-2014. Bleed rates were significantly lower with SLR±oversewing compared to stapling alone or oversewing. However, leak rates were significantly higher with SLR±oversewing. Compared to patients who developed bleeding, patients who developed a leak had 57% higher risk of 30-day readmission(p<0.001) and 31% higher risk of 30-day reoperation(p<0.001). BS had no impact on bleed rates but a BS 34-38 French had significantly higher leak rates. DP had no significant associations with outcomes.
CONCLUSIONS:
LSG is a safe procedure with postoperative leaks being significantly more morbid than bleeding. Higher leak rates are associated with SLR±oversewing and a BS 34-38 French. National surgical registries can be powerful tools to assess process measures and the safety and effectiveness of surgical techniques.


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